Provider Demographics
NPI:1134011166
Name:BERTHOLF, ANNA ELIZABETH (LPC)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:ELIZABETH
Last Name:BERTHOLF
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16000 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085-9346
Mailing Address - Country:US
Mailing Address - Phone:903-948-5192
Mailing Address - Fax:
Practice Address - Street 1:16000 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:KS
Practice Address - Zip Code:66085-9346
Practice Address - Country:US
Practice Address - Phone:903-948-5192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC04710101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional